How to File a Paid Family Leave Claim
How to Apply
Claim for Paid Family Leave (PFL) Benefits - If you are a woman currently receiving DI pregnancy-related benefits, it is not necessary to request a Claim form for Paid Family Leave Benefits, DE 2501F. You will automatically be sent a Claim Form for Paid Family Leave (PFL) Benefits - New Mother, DE 2501FP, when your pregnancy-related disability claim ends. If you have not received this form within 10 days after your disability claim ends please contact us at the telephone number below.
DE 2501F - To order a single claim form, please use Request a Claim Form for Paid Family Leave Benefits, or call 1-877-238-4373. You may also obtain a claim form for Paid Family Leave benefits at any of our Disability Insurance (DI) offices. For bulk orders, please use the Internet Order Form for EDD Forms and Publications .
Deaf, speech impaired and hard of hearing callers can contact PFL directly by Teletypewriter (TTY) 1-800-445-1312 (this number does not accept voice calls.)
See an example of a properly completed Claim for Paid Family Leave (PFL) Benefits, DE 2501F for individuals claiming benefits to provide care use DE 2501F - Sample claim form.
PFL provides services primarily by telephone, by mail, and in person. You do not need to apply in person to receive benefits.
| General Instructions | Additional Instructions |
|---|---|
| 1. Decide the date you want your claim to begin as this will determine your weekly benefit amount. | None. |
| 2. Complete ALL items on the "Claim for Paid Family Leave (PFL) benefits" and sign it. An original form must be submitted by claimants. It cannot be downloaded or reproduced. | How to complete the Paid Family Leave claim DE 2501F manually. |
| 3. Complete all portions of part B or part C depending on whether you will be taking time off work to bond or care. Both portions will need to be signed by the respective person. | None. |
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4. Doctor’s Certificate:
Ask your doctor to complete and sign the “Doctor’s Certificate” (page 3). The following licensed health care providers are authorized to sign the Doctor’s Certificate portion of the DE 2501F, for patients under their care and for conditions within their scope of practice:
|
Nurse Practitioner Certification For Paid Family Leave Benefits, DE 2509F |
| 5. Cannot Complete Form: If you cannot complete the claim form because of a disability, or if you are an authorized agent filing for benefits on behalf of a physically incapacitated, mentally incapacitated, or deceased claimant, you will need a separate form. | Call 1-877-238-4373 for further instructions. |
| 6. Religious Practitioner: If the care recipient is under the care of an accredited religious practitioner, you must include with your claim form a Practitioner’s Certificate, "DE 2502." Ask your practitioner to complete and sign it. (Rubber stamped signature facsimiles are not accepted.) | Call 1-877-238-4373 to get a Practitioner’s Certificate, “DE 2502.” |
| 7. Mail your claim to the PFL Office no earlier than 9 days--but no later than 49 days-- after the first day you began bonding or providing care. Mail your completed, signed "Claim for Paid Family Leave benefits" together with the completed, signed "Doctor’s Certificate." | None. |
NOTE: The United States Postal Service (USPS) will not deliver mail to a private mail box (i.e., a mail box rented to you by a non-USPS commercial enterprise) unless it is preceded by the initials “PMB.”
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